-

LAPORAN KASUS RUJUKAN PUSKESMAS…………………………………….
BULAN :......................................
JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa 0 0 0 0 ### 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Anemia ### 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Anxietas ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Appendicitis 0 0 1 6 0 5 0 0 0 4 0 0 3 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Arthrosis 0 0 6 15 0 7 0 0 4 7 0 0 10 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Arthritis 0 0 0 6 0 2 0 0 0 2 0 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Atresia of bile ducts 0 0 1 9 0 5 0 0 1 4 0 0 5 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Asma 0 0 0 6 0 4 0 0 0 2 0 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 BELL'S PALSY 0 0 3 12 0 11 0 0 4 8 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Benign Neoplasma of Breast 1 0 2 12 0 3 0 0 3 3 0 0 9 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Benign Neoplasma of Soft
Tissue 0 1 1 23 0 11 0 0 2 18 0 0 5 12 0 0 0 0 0 0 3 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0
12 Benign Lypome 0 0 4 7 0 2 0 0 2 5 0 0 4 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Benos pada Axilla 0 0 0 6 0 3 0 0 1 0 0 0 5 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Blighted Ovum 0 0 1 7 0 6 0 0 0 2 1 0 5 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
15 Broncho Pneumonia 1 0 0 15 0 8 0 1 0 10 0 1 4 7 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD 1 1 0 3 0 3 0 0 0 2 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Cardiomegali 0 0 1 8 0 5 0 0 0 7 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Chatarak 0 0 2 18 0 17 0 0 1 7 0 1 7 1 0 0 4 0 0 0 1 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0
19 Carpal Tunel Syndrome 0 0 1 8 0 2 0 0 1 0 0 0 8 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Cerebro Vascular 1 0 0 3 0 2 0 0 0 2 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Cervicitis 0 0 0 7 0 2 0 0 2 1 0 0 4 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Cholelithiasis 0 0 0 8 0 2 0 0 0 2 0 1 5 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 CHF 0 2 0 9 0 7 0 0 4 2 0 0 5 3 0 0 0 0 0 0 1 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0
24 Chalazion 0 0 0 6 0 3 0 0 2 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Chest Pain 0 0 0 15 0 6 0 0 0 7 0 0 8 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Cirrhosis of Liver 0 0 0 11 0 9 0 0 0 8 0 1 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Carcinoma 0 0 0 10 0 4 0 0 0 6 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0
28 Congenital Deformitas 0 2 1 3 0 3 0 0 0 3 0 0 3 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Constipasi 0 0 0 9 0 2 0 0 1 3 0 0 5 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Corpus Alienum 0 0 1 3 0 2 0 0 0 0 0 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Coronary Trombosis 0 0 2 5 0 3 0 0 1 2 0 0 4 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Chronik Apical Periodontis 0 1 1 8 0 4 0 0 1 3 0 0 6 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Chlamydia 0 0 2 5 0 2 0 0 3 1 0 0 3 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Cysta OVARIUM 2 0 0 3 0 2 0 0 0 2 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Colic Abdomen 0 0 1 8 0 5 0 0 0 3 0 0 6 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Depression 0 0 1 7 0 6 0 0 2 0 0 3 3 1 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis 0 1 1 5 0 3 0 0 1 3 0 0 2 3 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 DHF 0 0 1 4 0 3 0 0 1 2 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 DM 0 0 4 7 0 7 0 0 2 4 0 0 4 3 0 0 1 0 0 0 1 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0
40 Disease of Hard Tissue of
teeth 0 0 2 5 0 4 0 0 1 2 0 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Disorder Lipoprotein
Matabolism 0 0 1 6 0 5 0 0 2 4 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Disorder of LacrimaI System 0 0 0 14 0 8 0 0 3 5 0 0 6 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Disorder of Conjungtiva 0 0 0 8 0 6 0 0 1 2 0 0 5 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Disorder of Refraction
/Gangguan Visus 0 0 3 6 0 7 0 0 0 2 0 0 2 1 0 0 4 0 0 0 3 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0
45 Disorder of Invertebral Disc 0 0 1 7 0 4 0 0 4 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Disorder of Cervical 0 0 1 5 0 4 0 0 0 3 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Disosder of Metabolic 0 0 0 6 0 3 0 0 1 0 0 0 5 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Dyspepsia 1 1 0 3 0 3 0 0 0 2 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Dyspnoea 0 0 0 4 0 2 0 0 1 1 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Dyspareunia 0 0 1 3 0 2 0 0 2 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Effusi Pleura 0 0 0 6 0 4 0 0 2 4 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
52 End Stage Renal Disease 0 0 1 5 0 4 0 0 2 2 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
53 Endometriosis 0 0 0 6 0 3 0 0 2 0 0 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Epilepsy 1 0 0 3 0 2 0 0 0 2 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
55 External haemorrhoids with
other complications 0 0 1 4 0 2 0 0 1 1 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Fibro Adenoma Mammae 0 0 0 7 0 5 0 0 0 5 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Foreign Body in Ear 0 1 1 2 0 2 0 0 0 1 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Fracture 0 0 0 5 0 3 0 0 0 4 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Gastritis Ulcer 0 0 1 3 0 2 0 0 0 2 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Gastroentestinal
Haemorrahage 0 0 0 5 0 3 0 0 1 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 GERD 0 0 1 3 0 2 0 0 0 1 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Hamil dengan TB 0 0 2 2 0 2 0 0 1 3 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 High Risk Pregnancy 0 0 1 4 0 3 0 0 1 2 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Hematuria 0 0 0 4 1 2 0 0 1 2 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Heamorhoids 0 0 1 5 1 4 0 0 0 5 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
66 Headache Syndrom 0 0 0 4 1 2 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Head Injuri 0 0 1 3 1 2 0 0 3 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Hearing Loss 0 0 0 2 6 1 0 0 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Hernia 0 0 0 3 0 3 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Hirsprung Diseases 2 0 0 1 0 122 0 0 1 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Hordeolum 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Hyperplasia Prostat 0 1 0 4 0 2 0 0 0 3 0 0 2 3 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
73 Hyperthiroid 0 0 1 3 0 3 0 0 3 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
74 Hypermetrophy of Tonsil 0 0 0 4 0 2 0 0 1 0 0 0 2 2 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Hypertensive heart disease
without (congestive) heart 0 0 1 7 0 7 0 0 7 0 0 0 1 1 0 0 0 0 0 0 2 1 0 0 0 3 0 0 0 0 0 0 0 0 0 0
failure
76 Hypospedia 0 0 2 1 1 0 0 0 0 1 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Impacted teeth 0 0 0 2 1 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Incomplete Uterria 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
79 ISK 2 3 10 122 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Irregular Menstruation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Irritable Bowel Syndrome 0 0 1 1 0 2 0 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
82 IUFD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
83 Keloid 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Keratitis 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
85 Kista Baker's 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
86 Lithiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
87 Lymphadenitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
88 Lypoma 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Lymphangioma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Low Back Pain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
91 Lumbar and Other Interverbal
Disc Disorder with Mielopathy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
92 Lumbal Radikulopati 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
93 Malignant Neoplasm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
94 Mal union 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
95 Melanocytis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Maternal Care for Breech
Presentation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Mole Hydatidosa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
98 Mytral Stenosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99 Nontoxic Goitre 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100 Ovulation Bleeding 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
101 Otitis Media Kronis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
102 Ottalgia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
103 Otitis Externa in Mycoses 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
104 Other Specified Surgical States
(Post Op) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
105 Other Cholelithiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
106 other infective Bursitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Pain in thoracis spine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Peptic ulcer, unspecified as
acute or chronic, without 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
haemorrhage or perforation
110 Periapical abcess with sinus 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

111 Polip of nasal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
112 Polyhydramnion 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
113 Polymyalgia Rhematica 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Polyneurophathy 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Polyarthritis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Post Traumatic Joint 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
117 PPOK 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
118 Preeclamsia 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
119 Presbycusis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
120 Presbiopia 0 0 0 5 0 5 0 0 0 0 0 0 0 0 0 0 5 0 0 0 1 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0
121 Pterygium 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
122 Presence of Cardiac and
Vascular Implant and Graft 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
123 Prolaps Uteri 0 0 0 2 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
124 Prolonged Pregnancy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
125 Psikosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
126 Psoriasis Vulgaris 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 Penyakit Pulpa dan Jaringan
periapikal 0 0 2 5 0 7 0 0 0 0 0 0 0 0 0 0 0 7 0 0 2 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0
128 Radiculopathy 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Rematisme 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Renal Colic 0 0 0 2 0 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
131 Retention Urine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Salphingitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
133 Schizoprenia 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
134 Sinusitis 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
135 SLE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Spondylosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Sprain & strain shoulder 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Sequelae OF Stroke 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Err
139 Stroke 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 :5
Err
140 Struma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 09
:5
Err
141 Superficial Mycosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 09
:5
142 Superficial Insurgent 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 09
0
143 Susp Kista Odortogenik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
144 Susp Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
145 Susp TB MDR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0
147 Susp IUGR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
148 Tubercukosis paru-paru 0 0 1 3 0 4 0 1 3 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
149 Tubercukosis ekstra paru 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
150 TBC Meninitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
151 Trigger Finger 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
152 Tetraplegia, unspecified 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
153 Tinnitus 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
154 Tonsilitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
155 Ulcus Ventri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
156 Urolithiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
157 Vertigo 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
158 Vesicovaginal fistula 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
159 Ventricular Septal Defect 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
160 PENYAKIT LAIN 1 1 6 20 0 28 0 6 6 1 5 1 0 1 0 0 7 1 0 0 13 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0
JUMLAH 3 1 18 92 0 114 0 9 29 18 9 5 2 4 1 3 23 9 1 0 53 1 0 0 0 59 0 0 0 0 0 0 0 0 0 0
Mengetahui
Ka Puskesmas
RS RUJUKAN DI LUAR KAB. BANDUNG
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
KOTA
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
KOTA
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
KOTA
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
0 0 0 KOTA
0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
KOTA
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
0 0 0 KOTA
0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
KOTA
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
KOTA
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BANDUNG
HUMANA
SADIKIN
HASAN
HABIBI
PRIMA
KOTA
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 1
BULAN :......................................

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
7 Atresia of bile ducts
8 Asma
9 BELL'S PALSY
10 Benign Neoplasma of Breast
Tissue
12 Benign Lypome
13 Benos pada Axilla
14 Blighted Ovum
15 Broncho Pneumonia
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD
17 Cardiomegali
18 Chatarak
19 Carpal Tunel Syndrome
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
26 Cirrhosis of Liver
27 Carcinoma
28 Congenital Deformitas
29 Constipasi
30 Corpus Alienum
31 Coronary Trombosis
32 Chronik Apical Periodontis
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
42 Disorder of LacrimaI System
43 Disorder of Conjungtiva
/Gangguan Visus
45 Disorder of Invertebral Disc
46 Disorder of Cervical
47 Disosder of Metabolic
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
52 End Stage Renal Disease
53 Endometriosis
54 Epilepsy
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
other complications
56 Fibro Adenoma Mammae
57 Foreign Body in Ear
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
63 High Risk Pregnancy
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
70 Hirsprung Diseases
71 Hordeolum
72 Hyperplasia Prostat
73 Hyperthiroid
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
74 Hypermetrophy of Tonsil
without (congestive) heart
failure
76 Hypospedia
77 Impacted teeth
78 Incomplete Uterria
79 ISK
80 Irregular Menstruation
81 Irritable Bowel Syndrome
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
Disc Disorder with Mielopathy
92 Lumbal Radikulopati
93 Malignant Neoplasm
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
100 Ovulation Bleeding
101 Otitis Media Kronis
102 Ottalgia
103 Otitis Externa in Mycoses
(Post Op)
105 Other Cholelithiasis
106 other infective Bursitis
107 Pain in thoracis spine
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson
acute or chronic, without
110 Periapical abcess with sinus

111 Polip of nasal
112 Polyhydramnion
113 Polymyalgia Rhematica
114 Polyneurophathy
115 Polyarthritis
116 Post Traumatic Joint
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
Vascular Implant and Graft
123 Prolaps Uteri
124 Prolonged Pregnancy
125 Psikosis
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
126 Psoriasis Vulgaris
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
137 Sprain & strain shoulder
138 Sequelae OF Stroke
139 Stroke
140 Struma
141 Superficial Mycosis
142 Superficial Insurgent
143 Susp Kista Odortogenik
144 Susp Difteri
145 Susp TB MDR
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia
147 Susp IUGR
148 Tubercukosis paru-paru
149 Tubercukosis ekstra paru
150 TBC Meninitis
151 Trigger Finger
152 Tetraplegia, unspecified
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
158 Vesicovaginal fistula
159 Ventricular Septal Defect
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................

Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
Gol Umur RUJUKAN
ASTANA ANYAR
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
DUSTIRA
CISARUA
AVISENA
BBKKPM
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
LAPORAN RUJUKAN
PUSKESMAS :Nanjungmekar
BULAN : MEI
JUMLAH TOTAL KASUS RUJUKAN : 120
URAIAN KASUS RUJUKAN

JENIS RUJUKAN RS RUJUKAN
Gol Umur
NO
KASUS RUJUKAN RS RS RS
HASAN MAJALAY CICALENG RS RS AL
< 1 th 1 - 5 th 5 - 18 th > 18 th UMUM BPJS SKTM SADIKIN A KA SOREANG IHSAN RS AMC
1 ACUTE PERIODONTITIS 1 2 3 2 1
2 RADICULOPATY 5 5 2 3
3 DIABETIC RETINOPATY 1 1 1
4 HYPERPLASIA OF PROSTATE 3 3 3
5 PRE-ECLAMSIA 3 3 1 2
6 CATARACT 6 6 2 3 1
7 OF 1 1 2 1 1
8 COPD 3 3 2 1
9 PREMATURE RUPTURE OFMEMBRANES 1 1 1
10 CALCULUS OF KIDNEY 2 2 2
11 SECONDARY HYPERTENSION 2 2 2
12 HEART FAILURE 6 6 6
13 BENIGN NEOPLASM OF SKIN 2 2 2
14 INGUINAL HERNIA 3 3 2 1
15 TB 2 4 6 3 3
16 INJURY OF MUSCLE 1 1 1
17 HEADACHE 1 1 1
18 PLEURAL EFFUSION 1 1 1
19 FOLLICULAR CYST OF oVARY 1 1 1
20 EPILEPSY 1 1 1
21 PULPITIS 2 2 1 1
22 HHD 5 5 3 2
23 PRESBYOPIA 5 5 5
24 ACUTE SINUSITIS 1 1 1
25 heart disease 1 1 1
26 hypermetropia 1 1 1
27 keratitis 1 1 1
28 chf 1 1 1
29 impacteed teeth 1 1 1
30 surgical follow ap care 1 1 1
31 congenital absence of both fore arm and 1 1 1
32 periapical abscess with sinus 1 1 1
33 benign neoplasm of breast 1 1 2 2
34 DM 1 1 1
35 soft tissue tumour 1 1 2 1 1
36 myopia 3 3 1 2
37 otitis media suppurative kronik 2 2 1 1
38 irritable bowel syndrome without diarrhoea 4 4 1 3
39 benign mammary dysplasia 1 1 1
40 other anc 3 3 2 1
41 other arthrosis 1 1 1
42 deppresive episode 3 3 3
43 carcinoma cervix 1 1 1
44 vertigo 1 1 1
45 pneumonia 1 1 2 2
46 chronic obstructive gastritis 1 1 1
47 abortus incomplete 1 1 1
48 GERD 1 1 1
49 HYPERTROPY OF TONSIL 1 1 1
50 BENIGN NEOPLASM OF MEDDLE EAR 1 1 1
51 PERFORATION OF TYMPANIC 1 1 1
52 PARKINSON 1 1 1
53 blighted ovum 2 2 2
54 glaucoma 1 1 1
55 metomenorrhagia 1 1 1
56 lbp 1 1 1
57 GERD 1 1 1
58 asthma 1 1 1
59 schizoprenia 1 1 1
60 renal failure 1 1 1
61 schizoprenia 1 1 1
62 other anc 1 1 1
63 atrial fibrila 1 1 1
64 tb 1 1 1
120
dtp
dtp cicalengk
rsj cisarua rancaekek a
1
1
1
1
LAPORAN RUJUKAN
BULAN :APRIL

Gol Umur
NO
1 BENIGN MAMMARY DYSPLASIA 1 1 1
2 STROKE 2 2 1 1
3 OTHER BENIGN NEOPLASM SOFT TISSUE 1 1 1
4 EPILEPSY 1 1 2 1 1
5 PTERYGIUM 1 1 1
6 MYOPIA 3 2 5 3 2
7 DIABETIC NEUROPATY 1 1 1
8 PRESBYOPIA 1 1 1
9 BENIGN NEOPLASM OF BREAST 1 1 1
10 FRACTURE FEMUR 1 1 1
11 CHF 3 3 3
12 PNEUMONIA 1 1 1
13 PLEURAL EFFUSION 1 1 1
14 PULPITIS 1 1 2 2
15 CATARACT 7 7 1 4 2
16 HYPERPLASIA OF PROSTATE 1 1 1
17 OTHER SECONDARY OF HYPERTENSION 1 1 1

18 PSORIASIS 1 1 1
19 CONJUNTIVITIS 1 1 1
20 OTHER NEOPLASM SOFT TISSUE 2 2 2
21 NIDDM 1 1 1
22 PERIAPICAL ABSCESS 1 1 1
23 OTHER ANC 4 4 3 1
24 IMPACTEED TEETH 1 1 1
25 NECROSIS PULP 1 1 2 1 1
26 RENAL FAILURE 1 1 1
27 NONTOXIC GOITRE 1 1 1
28 TB 2 2 1 1
29 HEART FAILURE 3 3 3
30 VITILLIGO 1 1 1
31 HIRCSPRUNG 1 1 1
32 NIDDM 4 4 1 3
33 OTHER ARTRITIS 1 1 1
34 OTHER CHRONIC SUPPURATIVE OTITIS MEDIA 1 1 1
35 HHD 1 1 1
36 SURGICAL FOLLOW UP CARE 1 1 1
37 HHD 2 2 1 1
38 LONG LABOUR 1 1 1
39 COPD 7 7 1 5 1
40 GLAUCOMA 3 3 3
41 MYOPIA 1 1 1
42 OVARIAN CYST 1 1 1
43 BILATERAL INGINAL HERNIA 1 2 3 2 1
44 TINNITUS 2 2 2
45 MALIGNANT NEOPLASM OF BREAST 1 1 1
46 ANOMALIES OF TOOTH POSITION 1 1 1
47 SOMATOFORM DISORDER 1 1 1
48 BIPOLAR 2 2 2
49 ANC FOR FETAL GROWTH RETARDATION USING USG 1 1 1
50 RADICULOPATY 2 2 2
51 BP 1 1 1
52 FRACTURE FOOT 1 1 1
53 IRRITABLE BOWEL 3 3 2 1
54 OF 1 1 1
55 CALCULUS OF KIDNEY 1 1 1
56 OTHER BENIGN NEOPLASM OF SKIN 1 1 1
57 THYROTOXITOCIC 2 2 1 1
58 SCHIZOPRENIA 1 1 1
59 TREATENED ABORTION 1 1 1
60 PREMATURE RUPTURE OF MEMBRANES 2 2 2
61 THALASSAEMIA 1 1 1
62 PROLONGED PREGNANCY 2 2 2
63 OTHER SECONDARY HYPERTENSION 1 1 1
64 OTHER SPECIFIED DERMATITIS 1 1 1
65 HORDEOLUM 1 1 1
66 VERTIGO 2 2 1 1
67 DEPRESSIVE 1 1 1
68 BP 1 1 1
69 NASAL POLYP 1 1 1
70 LBP 1 1 1
71 SUPPURATIVE OTITIS MEDIA 1 1 1
72 INDDM 1 1 1
73 tb 1 1 1
74 TUMOR SUB MANDIBULA 1 1 1
IRRITABLE BOWEL 1 1 1
BKKM
2
LAPORAN RUJUKAN
BULAN :maret

Gol Umur
NO
< 1 th 1 - 5 th 5 - 18 th > 18 th UMUM BPJS SKTM SADIKIN A KA SOREANG IHSAN
1 BP 1
2 radiculopaty 3 1
3 COPD 1 1
4 Heart failure 4 4
5 Heart disease 1 1
6 Surgical follow up care 3 1 2
7 Presbyopia 5 2
8 Irritable bowel syndrome without diarrhoea 1 11 9
9 myopia 4 4 4
10 HHD 1
11 Internuclear opthalmophlegia 1
12 Other ANC 7 3 1
13 Pneumonia 1
14 Ca Breast 2 2
15 Hordeolum and chalazion 1
16 periapical abses with sinus 1
17 benign neoplasm of skin 1 1

18 pleural effuison 2 1
19 thyrotoxitocis 4 1
20 impactide teeth 3
21 sequale of stroke 1 1
22 cataract 6 3
23 psoriasis 1 1
24 COPD 4 4
25 Suppurative otitis media 1 1
26 periodonitis 1 1
27 thyroididtis 1
28 stroke 2 1
29 NIDDM with complication 2
30 pterygium 4 2
31 chronic bronchitis 1
32 gangrene 1 1
33 glaucoma 1 1
34 pulpitis 3 3
35 vertigo 1 1
36 DM with complication 3 1 2
37 fracture nasal 1
38 hearing loss 1 1
39 hyperplasia of prostate 1
40 benign neoplasm of upper limb 1
41 irreguler menstruation 1 1
42 blighted ovum 1 1
43 cholelithiasis 1 1
44 sinusitis chronis 2
45 benign neoplasm of tongue 1
46 trigeminal neuralgia 1 1
47 CHF 1 1
48 pre-exiting hypertension complication pregnancy 1 1
49 endometriosis 1 1
50 appendicitis 1
51 diabetic retinopaty 1 1
52 tinnitus 1
53 chronic maxilary sinusitis 1
54 foreign body of external eye 1
55 low vision 1
56 prolonged pregnancy 1 1
57 lbp 1 1
58 arthrosis of knee 1
59 premature rupture of membrane 1 1
60 epilepsy 1 1
61 schizoprenia 1 1
62 benign mammary dysplasia 1 1
63 deppression 1 1
64 other chronic otitis media 1 1
65 fracture ulna and radius 1 1
66 pulpitis
67 low birth 1 1
68 multiple delivery by caessarian 1 1
69 other tb 1 2 2
70 abortion incomplete 1 1
71 hernia 2 1
72 hypertropy of tonsil 1 1
73 of 1 1
74 necrosis pulp 1
2 3 10 122
JUKAN
RS AMC
1 1
2 3
1
4
1
3
3 5
3 12
4 8
1 1
1 1
3 7
1 1
2
1 1
1 1
1
1 2
3 4
3 3
1
3 6
1
4
2 2
1
1 1
1 2
2 2
2 4
1 1
1
1
3
1
3
1 1
1
1 1
1 1
1
1
1
2 2
1 1
1
1
1
1
1 1
1
1 1
1 1
1 1
1 1
1
1
1 1
1
1
1
1
1
1
1
0
1
1
1 3
1
1 2
1
1
1 1
LAPORAN RUJUKAN
BULAN :Februari
JUMLAH TOTAL KASUS RUJUKAN :119

Gol Umur
NO
1 Pulpitis 1 1
2 myopia 6 5 1 6 4
3 benign neoplasm of skin 3 1 2
4 calculus of kidney 1 1
5 polyneuropaty 1 1
6 cholelithiasis 1 1
7 irritable bowel syndrome 1 1 5 2 1 4
8 niddm 2 1 1
9 paralitic syndrome 1 1
10 presbyopia 2 1 1
11 appendicitis 1 1
12 abortion 1 1
13 otitis media 1 1
14 COPD 2 1 1
15 LBP 2 1 1
16 tinnitus 1 5 1 5
17 cholelitiasis 1 1
18 HYPERMETROPIA 3 1 2
19 scizophrenia 2 1 1
20 pneumonia 1 1
21 hyperplasia of prostate 2 2
22 benign neoplasm of breast 3 1 2
23 sinusitis 1 1
24 trigeminal neuralgia 2 2
25 MN of breast 1 1
26 cataract 6 1 1 4
27 of 1 1
28 heart disease 2 1 1
29 TB 1 1 2 3 1
30 irreguler menstruation 1 1
31 HHD 2 1 1
32 suppurative otitis media 1 2 3
33 pterygium 1 1
34 hypertropi of tonsil 1 1
35 artrhitis 1 1
36 benign neoplasm of prostate 1 1
37 benign neoplasm of head 2 1 1
38 arthrosis 1 1
39 radiculopaty 5 1 4
40 nasal polyp 1 1
41 necrosis pulp 1 1
42 female pelvic 3 1 2
43 hemorrhogic of respiratory 1 1
44 leiomyoma 1 1
45 depression 1 1
46 angina pectoris 1 1
47 retinoschisis 1 1
48 other anc 1 1
49 haemorrhoids 1 1
50 stroke 2 1 1
51 maternal care for breech presentation 1 1
52 pre-eclamsia 2 1 1
53 benign neoplasm of abdomen 1 1
54 hepatitis 1 1
55 chronic viral hepatitis 1 1
56 keratoconjuntivitis 1 1
57 asthma 1 1
58 epilepsy 1 1
59 vitili 1 1
60 impactid teeth 1 1
61 heart failure 1 1
62 of 1 1
63 arthritis 1 1
64 OMSK 1 1
65 6
LAPORAN KASUS RUJUKAN PUSKESMAS NANJUNG MEKAR
JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKA

Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia 1 1 1 1
3 Anxietas
4 Appendicitis 1 1 1 1
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY

Tissue 1 6 7 1 6
3 4
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
12 Benign Lypome
14 Blighted Ovum 1 1 1 1
15 Broncho Pneumonia 1 1 1 1
16 CAD
17 Cardiomegali
18 Chatarak 4 4 4 1 3
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF 4 4 4 1 3
24 Chalazion
25 Chest Pain
27 Carcinoma 2 2 2 2
29 Constipasi
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression 3 3 3 3
37 Dermatitis 1 1 1 1
38 DHF
39 DM 3 3 1 1 1 1 2
teeth
Matabolism
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
/Gangguan Visus
3 2 5 4 3 2
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura 1 1 1 1
52 End Stage Renal Disease 2 2 1 1 1 1
53 Endometriosis
54 Epilepsy
other complications
56 Fibro Adenoma mae
58 Fracture 1 1 1 1
59 Gastritis Ulcer
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids 1 1 1 1
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia 1 1 1 1
70 Hirsprung Diseases 1 1 1
71 Hordeolum
72 Hyperplasia Prostat 1 1 1 1
73 Hyperthiroid 2 2 2 2
74 Hypermetrophy of Tonsil 1 1 1 1
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
6 6 5 1 2 1 3
76 Hypospedia
77 Impacted teeth
79 ISK
81 Irritable Bowel Syndrome 1 1 2 2 2
82 IUFD
83 Keloid
84 Keratitis 1 1 1 1
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma 1 1 1 1
89 Lymphangioma
90 Low Back Pain
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson 1 1 1 1

1 1 1
1
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy 1 1 1 1
115 Polyarthritis
117 PPOK 1 1 1 1
118 Preeclamsia 1 1 1 1
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
119 Presbycusis
120 Presbiopia 5 5 5 1 4
121 Pterygium 1 1 1 1
123 Prolaps Uteri 2 2 2 1 1
125 Psikosis
periapikal
2 5 7 7 2 5
128 Radiculopathy 1 1 1 1
129 Rematisme
130 Renal Colic 2 2 1 1 1 1
131 Retention Urine
132 Salphingitis
133 Schizoprenia 1 1 1 1
134 Sinusitis 1 1 1 1
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia 1 1 1 1
147 Susp IUGR
148 Tubercukosis paru-paru 1 3 4 1 3 4
150 TBC Meninitis
151 Trigger Finger
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
153 Tinnitus 1 1 1 1
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
159 Ventricular Septal Defect 1 1 1 1
160 PENYAKIT LAIN 1 1 6 20 28 6 6 1 5 1 1 7 1 13 15
JUMLAH 3 1 18 92 0 114 0 9 29 18 9 5 2 4 1 3 23 9 1 0 53 1 0 0 0 59 0 0 0 0 0 0 0 0 0
114
Mengetahui
Ka Puskesmas
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
1
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
DUSTIRA
0
HASAN SADIKIN
0
HUMANA PRIMA
0
HABIBI
0
KOTA BANDUNG
1

Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia 1 1 1 1
3 Anxietas
4 Appendicitis 2 2 2 1 1
5 Arthrosis
6 Arthritis 1 1 1 1
7 Atresia of bile ducts 1 1 1 1
8 Asma 1 1 1 1
9 BELL'S PALSY
1 1 2
2 1 1
Tissue 3 9 12 12
6 6
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
12 Benign Lypome
14 Blighted Ovum 1 1 1 1
16 CAD
17 Cardiomegali
18 Chatarak 7 7 7 4 3
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF 4 4 3 1 1 2
24 Chalazion
25 Chest Pain
27 Carcinoma 4 4 1 2 1 1 1 2
29 Constipasi
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression 2 2 2 1
37 Dermatitis
38 DHF
39 DM 12 12 12 6 6
teeth
Matabolism
43 Disorder of Conjungtiva 1 1 1 1
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
/Gangguan Visus
3 12 15 15 7 8
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura 1 1 1 1
52 End Stage Renal Disease 2 2 2 2
53 Endometriosis
54 Epilepsy 1 1 2 2 2
other complications
58 Fracture 1 1 1 1
59 Gastritis Ulcer
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia 2 1 2 3 2 1
71 Hordeolum
73 Hyperthiroid 1 1 1 1
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
failure
1 5 6 5 1 1 1 4
76 Hypospedia
77 Impacted teeth 3 3 3 1 2
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis 2 2 2 2
87 Lymphadenitis 1 1 1 1
88 Lypoma
89 Lymphangioma
90 Low Back Pain 4 4 3 1 3 1
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre 1 1 1 1
101 Otitis Media Kronis 3 2 5 5 4 1
102 Ottalgia
(Post Op)
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson
111 Polip of nasal

112 Polyhydramnion
114 Polyneurophathy 1 1 1 1
115 Polyarthritis
117 PPOK 2 2 2 2
118 Preeclamsia 3 3 3 1 2
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
119 Presbycusis
120 Presbiopia 1 1 1 1
121 Pterygium 4 4 4 1 3
123 Prolaps Uteri
124 Prolonged Pregnancy 2 2 2 2
125 Psikosis
126 Psoriasis Vulgaris 1 1 1 1
periapikal
5 4 9 9 1 8
128 Radiculopathy 4 4 3 1 3 1
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
134 Sinusitis 1 1 1 1
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
135 SLE
136 Spondylosis
138 Sequelae OF Stroke 1 1 1 1
139 Stroke 1 1 1 1
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
Gol Umur RUJUKAN
NO KASUS RUJUKAN
BBKKPM CIBADAK
ASTANA ANYAR
KANDUNGAN
CICALENGKA
BINA SEHAT
SULAIMAN
MAJALAYA
SOREANG
PUSK DTP
JANTUNG
AL ISLAM
AL IHSAN
CICENDO
CISARUA
AVISENA
CIBABAT
KHUSUS
5 - 18 th
DALAM
SYARAF
UMUM
PONED
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
153 Tinnitus 1 1 2 2 2
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN 1 7 19 26 5 4 3 5 1 1 1 3 4 13 1 13
JUMLAH 2 0 31 142 1 172 0 7 41 29 13 9 2 12 1 10 31 16 4 1 82 3 1 0 0 86 0 0 0 0 0 0 0 0 0
175
Mengetahui
Ka Puskesmas
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
KLINIS KES. GRAHA ATMA
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
1
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
1
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
IMANUEL
KASIH BUNDA
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
DUSTIRA
0
HASAN SADIKIN
0
HUMANA PRIMA
0
HABIBI
0
KOTA BANDUNG
1
0
HERMINA
0
IMANUEL
0
KASIH BUNDA
0
MITRA KASIH
0
MUHAMADIYAH
0
0 PINDAD
…………………….. SANTOSA KOPO
0
Pembuat Laporan SARTIKA ASIH

0
SANTO YUSUP
0
ROTINSULU
0
RS LAIN
1
JENIS BAGIAN RUJUKAN
Gol Umur RUJUKAN
NO KASUS RUJUKAN
KANDUNGAN
JANTUNG
5 - 18 th
DALAM
SYARAF
UMUM
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
BPJS
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis 2 2 2
5 Arthrosis 1 1
6 Arthritis 1 1 1
8 Asma
9 BELL'S PALSY
1 1
1
Tissue 6 6 5 1
12 Benign Lypome
14 Blighted Ovum
15 Broncho Pneumonia 1 1 1 1 2
16 CAD
17 Cardiomegali
18 Chatarak 6 6 6
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis 1 1 1
23 CHF 5 5 5
24 Chalazion
25 Chest Pain
27 Carcinoma 1 1 2 1 1
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression 1 1 1
37 Dermatitis
38 DHF
39 DM 15 15 13 2
teeth
Matabolism
/Gangguan Visus
2 7 9 9
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy 2 2 4 1 3
other complications
58 Fracture 1 1 1
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD 1 1 1
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids 1 1 1
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia 3 3 2
71 Hordeolum
73 Hyperthiroid 3 3 3
74 Hypermetrophy of Tonsil 1 1 1
failure
17 17 14 3
76 Hypospedia
77 Impacted teeth 1 1
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre 1 1 1
102 Ottalgia
(Post Op)
108 Parkinson

1 1
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK 4 4 4
118 Preeclamsia 1 1 1
119 Presbycusis
120 Presbiopia 1 1 1
121 Pterygium
123 Prolaps Uteri
125 Psikosis
126 Psoriasis Vulgaris 2 2 2
periapikal
1 1 2
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia 1 9 10 1 9
134 Sinusitis 1 1 1
135 SLE
136 Spondylosis
139 Stroke 5 5 5
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
148 Tubercukosis paru-paru 1 1 7 3 6 1 8
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
159 Ventricular Septal Defect 1 1 1
160 PENYAKIT LAIN 3 21 1 24 2 3 1 7 2 3 1 5
JUMLAH 2 2 12 133 5 145 0 8 57 15 9 12 4 11 3 1 23
149
Mengetahui
Ka Puskesmas
KAN
GIGI
KHUSUS
1
AL IHSAN
AMC
2
1
1
3
1
5
1
1
2
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
4
3
1
1
1
PONED
RS RUJUKAN KAB. BANDUNG
PUSK DTP
ASTANA ANYAR
AVISENA
BINA SEHAT
BBKKPM CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN SADIKIN
HUMANA PRIMA
HABIBI
KOTA BANDUNG
HERMINA
1
3 12
4 5
3 1
1 1 2
1 2
1
5 3 9
1 1
2 1
1
1
1
3 1
1
2 1 1
2 8
1
5
6 3
1
1 11 13
5 2 1 72 5 0 0 0 71 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IMANUEL
KASIH BUNDA KAB. BANDUNG
MITRA KASIH
MUHAMADIYAH
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
1
0 0 0 0 0 0 0 0 0 1
……………………..
Pembuat Laporan

Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
JANTUNG
5 - 18 th
DALAM
SYARAF
UMUM
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
BPJS
THT
1 Adnexa
2 Anemia
3 Anxietas 4 4 4
4 Appendicitis
5 Arthrosis 1 1 1
6 Arthritis
8 Asma
9 BELL'S PALSY
10 Benign Neoplasma of Breast 1 2 3 3
Tissue 1 1 1
12 Benign Lypome
14 Blighted Ovum
15 Broncho Pneumonia 2 2 2
16 CAD
17 Cardiomegali
18 Chatarak 10 10 10
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis 1 1 1
23 CHF 5 5 5
24 Chalazion
25 Chest Pain
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression 4 4 4
37 Dermatitis
38 DHF
39 DM 11 11 11
teeth
Matabolism
/Gangguan Visus
3 5 8 8
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura 1 1 1
52 End Stage Renal Disease 1 1
53 Endometriosis
54 Epilepsy 1 1 2 4 1 3
other complications 1 1 1
58 Fracture 2 2 2
59 Gastritis Ulcer 1 1 1
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia 2 2 2
71 Hordeolum
72 Hyperplasia Prostat 1 1 1
73 Hyperthiroid
failure
1 6 7 5 2
76 Hypospedia
79 ISK
81 Irritable Bowel Syndrome 4 1 3 4
82 IUFD
83 Keloid
84 Keratitis 1 1 1
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain 3 3 3
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
101 Otitis Media Kronis 1 1 1
102 Ottalgia
(Post Op)
108 Parkinson
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK 4 4 4
119 Presbycusis
121 Pterygium 2 2 2
123 Prolaps Uteri
124 Prolonged Pregnancy 2 2 2
125 Psikosis
periapikal
1 1
128 Radiculopathy 5 5 3
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
134 Sinusitis
135 SLE
136 Spondylosis 1 1
139 Stroke 2 2 2
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
148 Tubercukosis paru-paru 2 2 2
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus 1 1 1
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo 2 2 2
160 PENYAKIT LAIN 1 3 29 1 32 4 4 2 9 3 3 2
JUMLAH 2 2 10 140 3 151 0 6 41 12 14 19 2 16 0 3 27
154
Mengetahui
Ka Puskesmas
drg Ani Mulyani

NIP 196206151994022002
KAN
GIGI
KHUSUS
1
AL IHSAN
1
AMC
2
1
1
5
1
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
4
5
2
1
2
1
3
PONED
PUSK DTP
ASTANA ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA ATMA
HERMINA
3 1
8 3
3 5
1
1 1
1 1
1
1 1
2
1
1 2 1 3
2 1 1
1 3
1
4
2
1 3
1 1
1 1
2 3 2
1 1
1 1
2
1
5 1 13 20
8 6 2 66 2 0 0 0 83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IMANUEL
KAB. BANDUNG
KASIH BUNDA
MITRA KASIH
MUHAMADIYA
H
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
2
0 0 0 0 0 0 0 0 0 2
……………………..
Pembuat Laporan
Resha Fatra Sigit, Amd RMIK


Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
JANTUNG
5 - 18 th
DALAM
SYARAF
UMUM
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
BPJS
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis 7 7 4 1 1
6 Arthritis
8 Asma 3 3 3
9 BELL'S PALSY
10 Benign Neoplasma of Breast 1 5 6 5 1
Tissue 1 1 2 2
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak 8 8 8
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis 1 1 2 2
23 CHF 12 12 12
24 Chalazion
25 Chest Pain
27 Carcinoma 3 3 1
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression 2 2 2
37 Dermatitis
38 DHF
39 DM 33 33 22 11
teeth
Matabolism
43 Disorder of Conjungtiva 1 1 1
/Gangguan Visus
1 9 10 10
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
52 End Stage Renal Disease 3 3 2
53 Endometriosis
54 Epilepsy 1 4 5 5
other complications
58 Fracture
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia 1 1 1
71 Hordeolum
failure
1 25 26 24 2
76 Hypospedia
79 ISK
81 Irritable Bowel Syndrome 1 1 1
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis 1 1 1
88 Lypoma
89 Lymphangioma
90 Low Back Pain
93 Malignant Neoplasm 1 1 1
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
102 Ottalgia
(Post Op)
108 Parkinson 1 1 1
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy 2 2 2
115 Polyarthritis
117 PPOK 9 9 9
119 Presbycusis
121 Pterygium 2 2 2
123 Prolaps Uteri
125 Psikosis
periapikal
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia 12 12 12
134 Sinusitis 1 1 1
135 SLE
136 Spondylosis
139 Stroke 3 3 2 1
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
148 Tubercukosis paru-paru 6 6 6
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus 4 4 4
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis 1 1
157 Vertigo 1 1 2 2
160 PENYAKIT LAIN 3 1 16 20 67 1 2 2 1 2 5
JUMLAH 1 4 11 201 0 217 0 67 98 13 6 16 2 17 3 9 40
217
Mengetahui
Ka Puskesmas
KAN
GIGI
KHUSUS
2
1
AL IHSAN
2
1
AMC
1
4
2
2
1
2
2
MAJALAYA
1
1
1
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
8
5
5
1
4
PONED
PUSK DTP
ASTANA ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA ATMA
HERMINA
1 1
11 1 21
4 6
1 1 1 1
3 1 1
1 1
1 1 2
1 2
1
12 4 10
1 1
1
2
1 8
1 1
3
2
2 1
1 11
1
3 1 2
1 2 1
1 1
2
1
11 1 7
1 5 4 85 16 3 0 0 106 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IMANUEL
KAB. BANDUNG
KASIH BUNDA
MITRA KASIH
MUHAMADIYA
H
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
0 0 0 0 0 0 0 0 0 0
……………………..
Pembuat Laporan
8

Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
JANTUNG
5 - 18 th
DALAM
SYARAF
UMUM
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
BPJS
THT
1 Adnexa
2 Anemia 1 1 1
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak 10 10 10
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF 2 2 2
24 Chalazion
25 Chest Pain
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM 1 1 1
35 Colic Abdomen
36 Depression 2 2 2
37 Dermatitis
38 DHF
39 DM 7 7 7
teeth
Matabolism
/Gangguan Visus
5 5 10 10
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
52 End Stage Renal Disease 1 1 1
53 Endometriosis
54 Epilepsy 1 1 1
other complications
58 Fracture 1 1 2 2
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia 3 3 3
71 Hordeolum
72 Hyperplasia Prostat 1 1 1
failure
7 7 7
76 Hypospedia
79 ISK
81 Irritable Bowel Syndrome 2 2 2
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis 1 1 1
87 Lymphadenitis 1 1 2 1 1
88 Lypoma
89 Lymphangioma
90 Low Back Pain 1 1
94 Mal union
95 Melanocytis
Presentation
1 1 1
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
108 Parkinson 1 1 1
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy 1 1 1
115 Polyarthritis
117 PPOK 2 2 2
118 Preeclamsia
119 Presbycusis
121 Pterygium 2 2 2
123 Prolaps Uteri
125 Psikosis
periapikal
1 1
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis 1 1 1
151 Trigger Finger
153 Tinnitus 2 2 2
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN 3 22 25 2 9 2 8 1
JUMLAH 3 3 13 113 0 131 0 7 39 21 11 9 0 7 0 4 27
132
Mengetahui
Ka Puskesmas
KAN
GIGI
KHUSUS
AL IHSAN
AMC
3
4
2
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
2
6
7
1
PONED
PUSK DTP
ASTANA ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA ATMA
HERMINA
1
1 1
5 2
3 7
1
1
1 1
1 2
1
1
2 5
1 1
1
2
1 1
1
1
1 1
4
1 1
1 1
1 4 1
1 6
1 4 4
1
1 1
1
2 17 8
4 2 0 57 0 0 0 0 70 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IMANUEL
KAB. BANDUNG
KASIH BUNDA
MITRA KASIH
MUHAMADIYA
H
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
0 0 0 0 0 0 0 0 0 0
……………………..
Pembuat Laporan

Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
JANTUNG
5 - 18 th
DALAM
SYARAF
UMUM
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
BPJS
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis 1 1 1
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak 8 8 8
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF 1 1 1
24 Chalazion
25 Chest Pain 1 1 1
27 Carcinoma 1 1 1
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen 1 1 1
36 Depression 2 2 2
37 Dermatitis 1 1 1
38 DHF
39 DM 2 2 2
teeth
Matabolism
/Gangguan Visus
6 6 12 12
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
53 Endometriosis
54 Epilepsy 1 1 2 1 1
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD 1 1 1
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss 1 1 1
69 Hernia 2 2 2
71 Hordeolum
failure
5 5 5
76 Hypospedia
79 ISK
81 Irritable Bowel Syndrome 1 2 3 3
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis 1 1 1
88 Lypoma
89 Lymphangioma
90 Low Back Pain 2 2 2
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
101 Otitis Media Kronis 1 1 2 2
102 Ottalgia
(Post Op)
108 Parkinson
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK 2 2 2
119 Presbycusis
121 Pterygium 1 1 1
123 Prolaps Uteri
125 Psikosis
periapikal
2 2
129 Rematisme
130 Renal Colic 1 1 1
131 Retention Urine
132 Salphingitis
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke 2 2 2
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia 1 1 1
147 Susp IUGR
149 Tubercukosis ekstra paru 1 1 1
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus 1 1 1
154 Tonsilitis 1 1 1
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN 4 4 15 22 5 4 6 1 1 4
JUMLAH 5 3 19 97 0 123 0 19 22 13 13 4 0 6 1 9 30
124
Mengetahui
Ka Puskesmas
KAN
GIGI
KHUSUS
AL IHSAN
AMC
1
3
2
1
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
1
1
5
5
PONED
PUSK DTP
ASTANA ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA ATMA
HERMINA
1
2
1
9 1 2
1 1
1
2
1 3
2
3
2 3
2 2
1 1
2
2
2 4
1 1
1
2 2
1 1 1
5 1 2
1
1
1
1
1 6 15 1
5 1 0 57 2 0 0 0 60 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IMANUEL
KAB. BANDUNG
KASIH BUNDA
MITRA KASIH
MUHAMADIYA
H
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
0 0 0 0 0 0 0 0 0 0
……………………..
Pembuat Laporan

Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
JANTUNG
5 - 18 th
DALAM
SYARAF
UMUM
BEDAH
1 - 5 th
> 18 th
ANAK
MATA
SKTM
KULIT
< 1 th
JIWA
BPJS
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis 1 1 1
6 Arthritis
8 Asma 1 2 3 1 2
9 BELL'S PALSY
10 Benign Neoplasma of Breast 7 7 7
Tissue
12 Benign Lypome
14 Blighted Ovum 1 1 1
15 Broncho Pneumonia 1 1 2 2
16 CAD
17 Cardiomegali
18 Chatarak 8 8 8
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis 1 3 4 1 2 1
23 CHF 9 9 9
24 Chalazion
25 Chest Pain
27 Carcinoma 5 5 5
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression 4 4 4
37 Dermatitis
38 DHF
39 DM 20 20 16 4
teeth
Matabolism
/Gangguan Visus
4 8 12 12
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
52 End Stage Renal Disease 3 3 1 1
53 Endometriosis
54 Epilepsy 3 3 3
other complications
58 Fracture 2 2 2
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom 1 1 1
67 Head Injuri
68 Hearing Loss
69 Hernia 1 1 1
71 Hordeolum
failure
16 16 14
76 Hypospedia
79 ISK
82 IUFD
83 Keloid
84 Keratitis 1 1 1
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
102 Ottalgia
(Post Op)
108 Parkinson
111 Polip of nasal
112 Polyhydramnion 1 1 1
114 Polyneurophathy
115 Polyarthritis
117 PPOK 7 7 7
118 Preeclamsia
119 Presbycusis
121 Pterygium 3 3 3
123 Prolaps Uteri
125 Psikosis
periapikal
2 4 6
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
134 Sinusitis 1 1 1
135 SLE
136 Spondylosis
139 Stroke 5 5 1 4
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia 1 1 2 2
147 Susp IUGR
148 Tubercukosis paru-paru 2 4 6 1 5
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus 1 1 1
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo 1 1 2 1 1
160 PENYAKIT LAIN 4 1 6 26 37 4 5 2 7 1 9
JUMLAH 6 3 21 186 0 216 0 13 76 20 10 18 0 12 2 2 41
216
Mengetahui
Ka Puskesmas
KAN
GIGI
KHUSUS
AL IHSAN
AMC
5
4
3
8
1
1
3
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
5
1
1
1
6
1
PONED
PUSK DTP
ASTANA ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA ATMA
HERMINA
2 2
5 15
7 5
1 3
1 1
1
1
1
2
2
1
2 5 2 9
4 1 3
1
1
3 4
2 1
3
6 6
2
1 13
1
1 1
5 1
1
1 1
7 2 1 16 1 18
17 5 1 99 4 0 0 0 111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IMANUEL
KAB. BANDUNG
KASIH BUNDA
MITRA KASIH
MUHAMADIYA
H
PINDAD
SANTOSA KOPO
SARTIKA ASIH
SANTO YUSUP
ROTINSULU
RS LAIN
1 (harapan keluarga)
0 0 0 0 0 0 0 0 0 1
……………………..
Pembuat Laporan

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LAPORAN KASUS RUJUKAN PUSKESMAS…………………………………….

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LU

110 Periapical abcess with sinus

URAIAN KASUS RUJUKAN

URAIAN KASUS RUJUKAN

17 OTHER SECONDARY OF HYPERTENSION 1 1 1

URAIAN KASUS RUJUKAN

17 benign neoplasm of skin 1 1

URAIAN KASUS RUJUKAN

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKA

11 Benign Neoplasma of Soft

110 Periapical abcess with sinus

JENIS BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKA

110 Periapical abcess with sinus

111 Polip of nasal

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

KLINIS KES. GRAHA ATMA

Pembuat Laporan SARTIKA ASIH

110 Periapical abcess with sinus

KLINIS KES. GRAHA ATMA

JENIS BAGIAN RUJUKAN

drg Ani Mulyani

Resha Fatra Sigit, Amd RMIK

JENIS BAGIAN RUJUKAN

JENIS BAGIAN RUJUKAN

JENIS BAGIAN RUJUKAN

JENIS BAGIAN RUJUKAN

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